Equis ISSN 2398-2977

Gastrointestinal: clostridiosis

Synonym(s): Clostridial enterocolitis

Contributor(s): Prof Jonathon Naylor

Introduction

  • Intestinal clostridiosis is a bacterial   Clostridium perfringens  infection which commonly causes severe diarrhea.
  • Cause:Clostridium perfringenstype A. Possible causes include: types B and C,Clostridium difficile  Clostridia spp  ,C. cadaverisorC. sordell. These bacteria are ubiquitous and therefore there must be an inciting cause.
  • Signs: severe and profuse watery diarrhea. Sudden death may also occur.
  • Diagnosis: is extremely difficult.
  • Treatment: relies on supportive therapy as well as antibiotics.
  • Prognosis: guarded to poor.

Pathogenesis

Etiology

  • Naturally occuring bacteriaClostridium perfringens  Clostridium perfringens  type A has been identified as a cause of acute colitis in adult horses. Other possible causes include:Clostridium difficile  Clostridia spp  ,Clostridium cadaveris,C. perfringensB and C   Clostridium perfringens  .

Predisposing factors

General
  • Recent antibiotic therapy can predispose to this disease.
  • Foals <5 days old are most susceptible, having least resistance.

Pathophysiology

  • Pathogenicity depends on production of enterotoxins.
  • Clostridial infection of the small and large intestines   →   severe damage to the bowel walls.
  • Leakage of fluid and electrolytes, and exudation of proteins occur into the bowel lumen, and absorption processes are decreased   →   diarrhea.
  • Increased bowel permeability facilitates the movement of gut bacteria and toxins into the blood stream   →   endotoxemia and septicemia.
  • Diarrhea, with endotoxemia and dehydration is the most common sequel, this can   →   death.
  • Insult allowsClostridiumbacteria, normally localized to lower GI tract and in small numbers, to proliferate and produce increased amounts of enterotoxin, especially in the large intestine.
  • The large intestinal disease attributed toC. perfringenstype A is manifested by hemorrhagic/necrotizing typhlocolitis.
  • Raised levels of inflammatory mediators such as prostaglandins, prostacycline and leukotrienes result in further inflammation of bowel wall.
  • Stimulation of fluid and electrolyte secretion and protein exudation into bowel lumen results.
  • This, together with decreased reabsorption of fluid, results in diarrhea, and, among other things, hypoproteinemia  163601  , hypoalbuminemia (protein-losing enteropathy)  163596  , and hypokalemia.
  • Increased permeability of intestinal microvasculature also results leading to endotoxemia   Endotoxemia: overview  .

Timecourse

  • Disease can occur within 3-4 days of initiating antibiotics; or other inciting cause.
  • Progression of disease is extremely rapid.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • South V (2014) Clostridial diseases of the horse. In Pract 36 (1), 27-33 VetMedResource.
  • Divers T J & Ball M (1996) Medical treatment of acute enterocolitis in the mature horse. Equine Vet Educ (4), 204-207 VetMedResource.
  • Wernery U, Nothelfer H B, Bohnel H & Collins W R (1996) Equine intestinal clostridiosis in a group of polo ponies in Dubai, UAE. Berl Munch Tiersrztl Wochenschr 109 (1), 10-13 PubMed.

Other sources of information

  • Rose R J & Hodgson D R (1993) Manual of Equine Practice. Saunders. ISBN 0 7216 3739 6.


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